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Benefits of postoperative shed blood reinfusion in patients undergoing unilateral total knee replacement

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Abstract

Introduction

In patients undergoing total knee replacement (TKR), most of the measured blood loss occurs during the postoperative period, and 30–50% of these patients receive allogeneic blood transfusion (ABT). For this reason, the salvage and return of unwashed filtered shed blood (USB) from postoperative drainage may represent an alternative to ABT in these patients. We have, therefore, evaluated the clinical utility of USB return in TKR patients, with a special focus on patients with mild anaemia.

Materials and methods

Data from 200 TKR patients (group 2) receiving USB within the first 6 postoperative hours (ConstaVac CBC II, Sryker) were prospectively collected. A retrospective series of 100 TRK patients served as the control group (group 1).

Results

USB return was possible in 162 patients who received a mean of 0.98±0.4 U/pte, without any clinically relevant incident. Return of USB decreased both the percentage of patients with ABT (48% vs 11%, for groups 1 and 2, respectively; p<0.01) and the ABT units/patient index (1.31±1.27 vs 0.29±0.87 units/patient, respectively; p<0.01). A transfusion protocol was not established, but there was no difference between groups with respect to either perioperative Hb levels or overall transfusion index, indicating that the transfusion criteria were uniform. However, for the subgroups of patients who needed ABT, the preoperative Hb level was 1 g/dL lower in those receiving USB (13.4±1.4 vs 12.4±1.2 g/dL; p<0.05). There was no difference in the postoperative complication rate, and patients in group 2 recovered the ability to walk 1 day earlier, and their hospital stay was 3 days shorter than in group 1 (p<0.01).

Conclusions

Return of USB after TKR seems to shorten the hospital stay and effectively reduce postoperative requirements for ABT, especially in patients with preoperative Hb >13 g/dL. For patients with preoperative Hb <13 g/dL, although the return of USB also decreased the requirements for ABT, a further reduction will probably be obtained with the addition of another blood-saving method.

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Acknowledgements

This study was financially supported by grant FIS PI 02/1826 from Instituto de Salud Carlos III (Spain) and the European Union, it was approved by the Ethics Committee of the University Hospital ‘Virgen de la Victoria’ (Málaga, Spain), and it complied with current Spanish laws.

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Authors and Affiliations

  1. GIEMSA, School of Medicine, University of Málaga, Campus de Teatinos, s/n, 29071, Málaga, Spain

    Manuel Muñoz

  2. Department of Anaesthesiology, University Hospital ‘Virgen de la Victoria’, Málaga, Spain

    Daniel Ariza & Aurelio Gómez

  3. Department of Orthopaedic Surgery, University Hospital ‘Virgen de la Victoria’, Málaga, Spain

    María J. Garcerán

  4. Department of Haematology, University Hospital ‘Virgen de la Victoria’, Málaga, Spain

    Arturo Campos

Authors
  1. Manuel Muñoz
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  2. Daniel Ariza
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  3. María J. Garcerán
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  4. Aurelio Gómez
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  5. Arturo Campos
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Correspondence to Manuel Muñoz.

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Muñoz, M., Ariza, D., Garcerán, M.J. et al. Benefits of postoperative shed blood reinfusion in patients undergoing unilateral total knee replacement. Arch Orthop Trauma Surg 125, 385–389 (2005). https://doi.org/10.1007/s00402-005-0817-3

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  • DOI: https://doi.org/10.1007/s00402-005-0817-3

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